Eye pain related to SM?
I was wondering if anyone has found that eye pain is a symptom of SM?
Sammy has been on 5mg prednisone every other day for SM for 5 years. He has done amazingly well for all that time with very few symptoms despite having been in a really bad state when he was young (gabapentin wasn't enough).
About a week ago, however, I noticed him squinting his right eye quite a bit. I gave him some gabapentin that I keep in case of pain episodes and it seemed to help. He was then fine the rest of the week. But today I came home from work and both of his eyes were half closed. He was still energetic and tail-wagging but clearly in some pain. I gave him 150mg gabapentin and again it helped (though it's also made him drowsy).
I'll take him to the vet soon, but I wanted to find out if others have experienced this kind of eye pain as part of SM? Could it be a sign the SM is finally getting worse? Prior to prednisone his symptoms were scratching like crazy, chewing his paws and rubbing his head frantically.
With Aled, half-closed eyes are a definite sign of pain, together with being rather subdued. If I increase his gabapentin, his eyes almost immediately become much larger and he is far more alert and lively. Oliver has always squinted in strong light, both sun and artificial light; his main symptom of CM/SM is frequent headaches and I think he squints because his head is aching and light makes it worse. He wears a sun hat in the summer and is on new medication that really helps the headaches. On his bad days he will half close his eyes even against bright cloud light coming through the windows. Gabapentin has never seemed to touch his headaches, which are more due to pressure inside the skull produced by severely dilated ventricles, I think, rather than straight neurological pain.
Have you noticed whether Sammy's painful eye days are related to days when the air pressure goes up or down sharply? Many CM/SM dogs are affected by this, and it may be giving Sammy pain in his ventricles behind the eyes and making his eyes hurt as well.
Always something new with SM! It is, of course, a progressive disease and so will change/develop over time. I hope your vet can help Sammy.
Kate, Oliver and Aled
I've never noticed a connection between the weather and his symptoms before, but we did have our first freezing temperatures in Finland yesterday, so it could be related. If he is getting worse, I'm not sure what to do. I doubt that giving prednisone and gabapentin together continually is recommended, but other than upping the prednisone and seeing if he tolerates that, I don't think there's much choice.
Today he's been ok though without any gabapentin. No squinting thus far. So hopefully it isn't about the eyes themselves (I was also worried that long term prednisone could be causing eye problems). My vet's office isn't open until Monday, but it looks like we're ok till then.
Now he started spinning in circles with his back leg raised, despite getting gabapentin a couple of hours ago. He's never done that before. It lasted less than a minute and he seems back to normal but it was really distressing to see! :(
Just back from a trip to an emergency vet at 1am. He lost balance again, started lip-licking and his eyes started to look erratically from left to right, almost as though he was following something that wasn't there. She couldn't find anything else wrong with him, so we have to assume it's the SM. Nothing we can do but add omeprazole and hope it passes. He's sleeping now. I'm kindof in shock.
Update: Sammy is experiencing classic symptoms of a 'vestibular episode', except he isn't really tilting his head. Since returning from the vet, he has gotten worse. He is now unable to walk or focus his sight. It is absolutely unbearable to see him like this, gut-wrenching. I don't know what to do.
Another update: Sammy has been able to walk better today. His eyes are still flickering and he is now starting to head tilt. But otherwise he seems a bit happier than last night. I'm wondering if it might be a middle ear problem and not related to sm. The vet couldn't see any signs of bulging in the outer ear though. Has anyone experienced this before? Was a recovery possible?
When I read your post last night my first thought was a vestibular episode, but I didn't have time to reply. Riley's SM has badly damaged her vestibular system so most of her SM symptoms are vestibular. She circles leading with her head, she frequently loses her balance - sometimes just when sitting, she sometimes has to lean against a wall for balance, she has 'vestibular episodes' in which her head whips backwards and she has nystagmus (her eyes look like Sammy's) several times a day and then won't have then again for several weeks. All of this is better since her surgery, but it's still there. BUT, she is a happy dog, like Sammy is now and she just picks herself up after an episode and keeps on going. Some dogs have vestibular episodes unrelated to SM though and they recover and it may or may not recur. For Sammy, I don't know which it might be. My guess would be, SM related. I'm glad he's feeling better. It is terrifying to watch.
Bev's given a very good answer that encompasses both 'normal' vestibular sessions and that some dogs with SM seemingly can become prone to them. I do hope he keeps improving now. The erratic movement of the eyes is a classic sign of a vestibular episode (but also can be seen with CM/SM).
Thank you so much for your responses! Sammy is an incredibly resilient little dog. He's so determined to keep doing everything he wants to do that he has been learning to balance again in hyper-speed. He's gone from hardly able to stand up last night to being able to walk down stairs this evening (with a harness and leash). He is still so determined, for example, to pee on every tree that if he topples over he just gets back up and tries again. And already he isn't toppling any more. I've gone from despair to amazement at his tenacity.
If these episodes are continual though, it isn't much quality of life. I just have to adjust his medication and hope for the best. I'm scared to give him gabapentin now, as yesterday's episode occurred about an hour after getting a 150mg dose. Of course it isn't necessarily cause and effect, but I'm terrified of it happening again. I'll take him for kidney/liver counts tomorrow and see if upping his prednisone is possible. And he hasn't been on omeprazole since he was young, so I'll keep him on that permanently now. Last night was really traumatic - the thought of losing Sammy was unbearable. But of course it has to be faced eventually.
Like Sammy, Riley just picks herself up and keeps on going. When she can't jump up on furniture, she'll keep trying (she never makes it, but bless her she keeps trying). We have steps for most of the furniture now. Prednisone is the only medication that has worked for her. She was on 5 mg daily for 6 years up until recently when we felt like we could start weaning her down a bit. Maybe you could try Sammy at 5 mg/day for awhile and see if that makes a difference. Good luck and don't give up yet!!!
Oh, please don't withhold gabapentin. This is really important for pain relief for SM dogs and is extreme;y unlikely to have caused any problems. Vestibular episodes are a separate issue and if left without gabapentin for pain, I'd suspect there's actually a greater likelihood of a repeat session due to pain and stress. :thmbsup: In a decade of talking to researchers and having discussions here with others with affected dogs, I have never heard of gabapentin being linked to vestibular episodes. The chance is miniscule of it being gabapentin, which is actually originally a drug used to manage seizures.
Glad he is already doing better. Vestibular episodes likely appear worse than what the dog experiences, so please do not feel this is necessarily a lower quality of life. :flwr:
Vestibular episodes seem to be primarily treated with short term steroids and antibiotics.